Bone Bruises
By Bob Paull, APEX Physical Therapy

A Bone Bruise – What Is It?

Bones are composed of a network of fibers that make up their structure.  In between the fibers is calcium.  If a bone is damaged in a traumatic fall, injury or collision, you can damage a small number of these fibers and cause a BONE BRUISE.   This condition is called a periosteal bruise and occurs when the outer layer of a bone, called the cortex, sustains small breaks following an injury or trauma.

A bone bruise is not a complete fracture of the bone and is not routinely detectable by an X-ray. (Most bone bruises are only detectable with an MRI).  The mechanism of the injury may include a fall, high impact injury with another player or landing from a jump.  Most bone bruises occur at the knee, ankle and hip and have also been diagnosed at the finger, wrist and elbow.

When a bone is bruised during an injury, often the muscles and tissues that surround the affected bone are  damaged.  Tissue damage can include cartilage and the surrounding ligaments.  Some new research indicates that permanent damage to the bone and cartilage may occur with a severe bone bruise and lead to early arthritic changes, especially at the knee

Extensive swelling and bleeding at the area may be present.  Sensitivity of the area with an increase in temperature is usually present.  Within a day or two of the injury, the damaged skin may appear blue or purple due to pooled blood beneath the skin.  As the area begins to heal, the skin may begin to turn green or yellow in color much like an ankle sprain.

How do I know if you have a fracture, a bone bruise or a just a sprain?  The first course of treatment is to have an X-ray of the area to rule out a fracture.  A fracture is a serious medical condition and must be attended to appropriately, according to the American College of Sports Medicine.  If the pain is great or there is an extensive amount of swelling or discoloration, your health care provider may order an MRI to rule out bone bruise.  If the X-ray and MRI are normal, you probably just have a sprain.

Immediate care of a bone bruise includes ice and elevation.  In severe cases you may be non-weight bearing for a period of time and may have to use crutches.  Rest and a reduction of activity may be indicated.  As with every injury, the time line for complete recovery varies tremendously.

Bruised bones are painful and, unfortunately, can last for a long period of time.   While discoloration and swelling subside, the pain of a bone bruise persists.  Some bone bruises resolve in a few days, where others linger and the pain finally resolves in a few months. 

For more information on bone bruises or periosteal bruising, visit the U.S. National Library of Medicine  and the National Institutes of Health.